Study: Employer points systems drive workers to show up sick

A new study finds that employer points systems, which penalize workers for absences regardless of the reason, are strongly associated with presenteeism, the practice of showing up to work while sick, and that these systems undermine the public health benefits of paid sick leave laws even in jurisdictions where such protections are on the books. Published in the June 2026 issue of Health Affairs, the research, Points-Based Attendance Systems Associated With Presenteeism Despite Paid Sick Leave Protections, draws on 2024 survey data from more than 3,000 hourly service-sector workers at 63 large U.S. firms. 

Points-based attendance systems are policies under which employees accumulate points, occurrences, or demerits for being late, leaving early, or missing work for any reason, including illness, with consequences that can include termination. These systems are widespread among large retail, grocery, pharmacy, fast food, and fulfillment employers. Despite growing adoption of paid sick leave laws at the state and local level, nearly half of workers in the study reported being subject to a points system, regardless of whether their employer operated in a jurisdiction with a paid sick leave mandate. 

Key findings 

Drawing on data collected through the Shift Project, the researchers found that exposure to a points system was associated with an 18.9-percentage-point increase in presenteeism. The effects followed a clear gradient based on the degree of exposure: workers subject to a points system but who had not personally accrued points were 9.3 percentage points more likely to work while sick than those not exposed to any such system. Workers who had accrued points were 29.5 percentage points more likely to come in sick, and those who had both accrued points and faced consequences were 38.7 percentage points more likely to do so. 

The threat of points shaped worker behavior even before penalties were incurred, suggesting that the mere presence of a points system creates an incentive structure that discourages workers from staying home when ill. Exposure to a points system was also associated with an 18.1-percentage-point increase in the likelihood that workers reported coming in sick specifically to avoid losing or earning a point. 

Critically, paid sick leave mandates did not reduce the likelihood that employers used points systems, nor did they moderate the relationship between points systems and presenteeism. Workers covered by paid sick leave laws were just as likely to show up sick under a points system as those without such legal protections. These findings suggest that points-based attendance systems are effectively nullifying the public health benefits that paid sick leave laws are designed to deliver. 

The stakes are particularly high in the service sector, where workers are often customer-facing and involved in food handling, preparation, or service, settings where communicable disease transmission poses a direct public health risk. 

While employers have a justifiable business need to ensure staffing, our work shows that points systems go far beyond those purposes, punitively sanctioning working people in ways that undermine their health and the public health."

Daniel Schneider, the Malcolm Wiener Professor of Social Policy, Harvard Kennedy School and co-director of the Shift Project